Posterior Tibial Tendon Injury

WHAT IS A POSTERIOR TIBIAL TENDON INJURY?

A posterior tibial tendon injury is a problem with the tendons and muscles that extend from the back of your lower leg to your inner ankle and foot. Tendons are strong bands of tissue that attach muscle to bone. You use the posterior tibial tendon when you point your foot down and in, stand on your toes, and when you walk or run.

Tendons can be injured suddenly or they may be slowly damaged over time. You can have tiny or partial tears in your tendon. If you have a complete tear of your tendon, it’s called a rupture. Other tendon injuries may be called a strain, tendinosis, or tendonitis.

WHAT IS THE CAUSE?

A posterior tibial tendon injury can be caused by:

Overuse of the tendon, such as from lots of running, intense exercise, or sports training or from doing a lot of work that causes you to bend at the knees and ankles.

A sudden activity that twists or tears your tendon, such as jumping, starting to sprint, or a fall.

You are more likely to have a posterior tendon problem if you have a problem called over-pronation, which happens when your feet roll inward and your arch flattens out more than normal when you walk or run.

WHAT ARE THE SYMPTOMS?

Symptoms may include:

Pain or tenderness on the inner side of the shin, ankle, or foot
Pain with lifting your foot
Pain when you walk or run

HOW IS IT DIAGNOSED?

Your healthcare provider will examine you and ask about your symptoms, activities, and medical history. You may have X-rays or other scans.

HOW IS IT TREATED?

You will need to change or stop doing the activities that cause pain until the tendon has healed. For example, you may need to swim instead of run.

Your healthcare provider may recommend stretching and strengthening exercises to help you heal. Special shoes or shoe inserts may help.

If you have a severe injury, your healthcare provider may put your leg in a splint or cast for several weeks to keep it from moving while it heals.

You may need to use crutches until you can walk without pain.

The pain often gets better within a few weeks with self-care, but some injuries may take several months or longer to heal. It’s important to follow all of your healthcare provider’s instructions.

HOW CAN I TAKE CARE OF MYSELF?

To help relieve swelling and pain:

Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth, on the area every 3 to 4 hours.Do ice massage. To do this, first freeze water in a Styrofoam cup, then peel the top of the cup away to expose the ice. Hold the bottom of the cup and rub the ice over your tendon for 5 to 10 minutes. Do this several times a day while you have pain.

Keep your lower leg and foot up on a pillow when you sit or lie down.

Take pain medicine, such as acetaminophen, ibuprofen, or other medicine as directed by your provider.

If the pain is longer than 2 weeks then use Moist heat may help relax your muscles and make it easier to move your leg. Put moist heat on the injured area for 10 to 15 minutes at a time before you do warm-up and stretching exercises. Moist heat includes heat patches or moist heating pads that you can purchase at most drugstores, a wet washcloth or towel that has been heated in the dryer, or a hot shower. Don’t use heat if you have swelling

Warm-up exercises and stretching before activities can help prevent injuries. If your shin, ankle, or foot hurts after exercise, putting ice on it may help keep it from getting injured.

Follow safety rules and use any protective equipment recommended for your work or sport. For example, wear the right type of shoes for your activities. Taping your foot can give extra support to your arch.

EXERCISE

Prone Hip Extension: Lie on your stomach with your legs straight out behind you. Fold your arms under your head and rest your head on your arms. Draw your belly button in towards your spine and tighten your abdominal muscles. Tighten the buttocks and thigh muscles of the leg on your injured side and lift the leg off the floor about 8 inches. Keep your leg straight. Hold for 5 seconds. Then lower your leg and relax. Do 2 sets of 15.

Side-lying Leg Lift: Lie on your uninjured side. Tighten the front thigh muscles on your injured leg and lift that leg 8 to 10 inches (20 to 25 centimeters) away from the other leg. Keep the leg straight and lower it slowly. Do 2 sets of 15.

Towel Stretch: Sit on a hard surface with your injured leg stretched out in front of you. Loop a towel around your toes and the ball of your foot and pull the towel toward your body keeping your leg straight. Hold this position for 15 to 30 seconds and then relax. Repeat 3 times.

Standing Calf Stretch: Stand facing a wall with your hands on the wall at about eye level. Keep your injured leg back with your heel on the floor. Keep the other leg forward with the knee bent. Turn your back foot slightly inward (as if you were pigeon-toed). Slowly lean into the wall until you feel a stretch in the back of your calf. Hold the stretch for 15 to 30 seconds. Return to the starting position. Repeat 3 times. Do this exercise several times each day.

Heel Raise: Stand behind a chair or counter with both feet flat on the floor. Using the chair or counter as a support, rise up onto your toes and hold for 5 seconds. Then slowly lower yourself down without holding onto the support. (It’s OK to keep holding onto the support if you need to.) When this exercise becomes less painful, try doing this exercise while you are standing on the injured leg only. Repeat 15 times. Do 2 sets of 15. Rest 30 seconds between sets.

Step-up: Stand with the foot of your injured leg on a support 3 to 5 inches (8 to 13 centimeters) high –like a small step or block of wood. Keep your other foot flat on the floor. Shift your weight onto the injured leg on the support. Straighten your injured leg as the other leg comes off the floor. Return to the starting position by bending your injured leg and slowly lowering your uninjured leg back to the floor. Do 2 sets of 15.

Balance and Reach Exercises: Stand next to a chair with your injured leg farther from the chair. The chair will provide support if you need it. Stand on the foot of your injured leg and bend your knee slightly. Try to raise the arch of this foot while keeping your big toe on the floor. Keep your foot in this position.

With the hand that is farther away from the chair, reach forward in front of you by bending at the waist. Avoid bending your knee any more as you do this. Repeat this 15 times. To make the exercise more challenging, reach farther in front of you. Do 2 sets of 15.

While keeping your arch raised, reach the hand that is farther away from the chair across your body toward the chair. The farther you reach, the more challenging the exercise. Do 2 sets of 15.

If you have access to a wobble board, do the following exercises:

Wobble board exercises.

Stand on a wobble board with your feet shoulder-width apart.

Rock the board forwards and backwards 30 times, then side to side 30 times. Hold on to a chair if you need support.

Rotate the wobble board around so that the edge of the board is in contact with the floor at all times. Do this 30 times in a clockwise and then a counterclockwise direction.

Balance on the wobble board for as long as you can without letting the edges touch the floor. Try to do this for 2 minutes without touching the floor.

Rotate the wobble board in clockwise and counterclockwise circles, but do not let the edge of the board touch the floor.

When you have mastered the wobble exercises standing on both legs, try repeating them while standing on just your injured leg. After you are able to do these exercises on one leg, try to do them with your eyes closed. Make sure you have something nearby to support you in case you lose your balance.